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Disability Benefits for Dysautonomia

Social Security Disability Lawyers: Riverside, Orange & North San Diego Counties

Dysautonomia

“Dysautonomia” is the term used to describe a dysfunction of the autonomic nervous system, which is called “autonomic” because it is the part of the nervous system that controls autonomic or involuntary functions that you don't think about, such as your heart rate, breathing, blood pressure, swallowing, and the passage of food through your stomach and intestinal tract. The autonomic nervous system handles these vital functions “automatically,” without any voluntary effort on your part.

When the autonomic nervous system malfunctions, it can cause serious problems with blood pressure, the heart, breathing, swallowing, and other digestive functions. Dysautonomia often occurs on its own (“primary”), but sometimes It may be associated with other medical conditions (“secondary”), such as Parkinson's disease, alcoholism and diabetes.

The National Institutes of Health describe “Dysautonomia” as a dysfunction of the “autonomic nervous system (ANS) function that generally involves failure of the sympathetic or parasympathetic components of the ANS, but dysautonomia involving excessive or overactive ANS actions also can occur. Dysautonomia can be local, as in reflex sympathetic dystrophy, or generalized, as in pure autonomic failure. It can be acute and reversible, as in Guillain-Barre syndrome, or chronic and progressive. Several common conditions such as diabetes and alcoholism can include dysautonomia. Dysautonomia also can occur as a primary condition or in association with degenerative neurological diseases such as Parkinson's disease. Other diseases with generalized, primary dysautonomia include multiple system atrophy and familial dysautonomia. Hallmarks of generalized dysautonomia due to sympathetic failure are impotence (in men) and a fall in blood pressure during standing (orthostatic hypotension). Excessive sympathetic activity can present as hypertension or a rapid pulse rate.” [Ref} https://www.ninds.nih.gov/Disorders/All-Disorders/Dysautonomia-Information-Page

The National Institute of Neurological Disorders and Stroke (NINDS) conducts multiple clinical trials and research into the causes and treatments of dysautonomia.

Symptoms and Types of Dysautonomia

Symptoms of dysautonomia can frequently include an inability to stay upright because of dizziness, vertigo, and fainting, fast, slow, or irregular heartbeat, and symptoms that overlap with POTS (postural orthostatic tachycardia syndrome).

Patients with dysautonomia may have chest pain, labile or unstable blood pressure, nausea, other gastrointestinal symptoms, migraine headaches, and problems with vision.

There are different types of dysautonomia. Some patients with dysautonomia may experience “baroreflex” dysfunction. The baroreflex is the body's mechanism for adjusting and maintaining a stable blood pressure. Patients who have dysfunction of the baroreflex can have wide fluctuations in their blood pressure, from very low (which places them at risk for falling) to very high (which can cause stroke).  

Patients with diabetes mellitus may develop “diabetic autonomic neuropathy”, which is probably the most common form of autonomic dysfunction (estimated to occur in about 20% of all diabetics).

There is a serious “familial dysautonomia” that is due to a rare genetic disorder seen mostly in Ashkenazi Jews. However, other types of milder dysautonomia may occur in families (e.g., POTS), which are not “familial dysautonomia.”  

Reflex Sympathetic Dystrophy (Complex Regional Pain Syndrome) may be a form of dysautonomia. Reflex Sympathetic Dystrophy (RSD) is an extremely painful neurological condition. Many doctors believe that the autonomic nervous system is involved in perpetuating the chronic pain that occurs with this disorder.

Diagnosis

To diagnose dysautonomia, sometimes a tilt-table test is performed. This test evaluates how a patient's blood pressure responds to when the table is tilted upward.

A sweat test can also be helpful in the diagnosis of dysautonomia. This test is performed while a patient is lying in a chamber where the temperature is slowly increased. A series of digital photos document the sweat pattern, which can help confirm a diagnosis of autonomic neuropathy.

Laboratory testing for diabetes and for autoimmune antibodies, such as anti-nuclear or Sjogren's antibodies, may be helpful in some cases.

Treatment

There is no known cure for dysautonomia. Secondary forms, such as when dysautonomia occurs in patients who have Parkinson's or diabetes, may improve with treatment of the underlying disease. However, treatment of primary dysautonomia is symptomatic and supportive, such as elevation of the head of the bed, adequate hydration, high-salt diet, and medications that include fludrocortisone and midodrine.

In a peer-reviewed medical journal article published by Schofield and Chemali, treatment with intravenous gammaglobulin infusions (“IVIG”), particularly in patients with autoimmune factors, appeared promising to the point that the authors concluded that “there is increasing evidence that IVIG is safe and effective in a subset of patients with autonomic disorders and evidence for autoimmunity. A 4-month IVIG trial should be considered in severely affected patients who are refractory to lifestyle and pharmacological therapies.” Intravenous Immunoglobulin Therapy in Refractory Autoimmune Dysautonomias: A Retrospective Analysis of 38 Patients. Am J Ther. 2019 Sep/Oct;26(5):570-582.

Prognosis

The prognosis can vary quite widely depending on the type and severity of the dysautonomia. Unfortunately, patients with chronic, progressive, generalized dysautonomia in the setting of central nervous system degeneration can have a generally poor long-term prognosis. Disability and death can occur from pneumonia, acute respiratory failure, or sudden cardiopulmonary arrest.

However, there are many patients with milder forms of dysautonomia, including patients with POTS, that have a much more favorable prognosis.

Long-Term Disability Benefits for Dysautonomia

Dysautonomia may be completely disabling in some patients, who may not be able to perform even a desk job, because of dizziness, vertigo, fainting, fast, slow, or irregular heartbeat, labile fluctuations of blood pressure, and other symptoms that include headaches and fatigue.

Finding a doctor who has experience with dysautonomia and understands how to diagnose, treat, and document this condition is the first step.  The type of doctor could be a cardiologist, neurologist, rheumatologist, or a gastroenterologist. That depends on the nature of your symptoms.

It is also important to find a disability lawyer who understands dysautonomia and has experience with successfully obtaining disability benefits, whether through Social Security (SSDI) or an employer-based long-term disability plan (ERISA), for this condition.

At Law Med, we understand dysautonomia and can work with your doctor to help you get long-term disability (LTD) benefits that you deserve.

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